Table 4. Summary characteristics of selected provinces.
| Apayao | Benguet | Cavite | Laguna | |
|---|---|---|---|---|
| Environment and ecology | Minimal infrastructure and mountainous terrain limits access to high-risk groups. | Mountainous terrain and remote municipalities are challenges for service delivery. | Rapid industrialization and development has reduced/polluted breeding sties. | Widespread urbanization and economic development eliminated breeding places. |
| Prevalence of mining and logging in forested areas increase worker vulnerability. | Continued presence of vectors contributes to receptivity. | Primary and secondary vectors still thrive in areas with clear slow flowing streams. | Endemic areas are less-developed, remote, and ecology favors mosquito breeding. | |
| Malaria epidemiology | Entire province is highly endemic. | Higher elevation, cooler climate contribute to lower transmission and receptivity. | Few endemic areas. | Entire province was endemic prior to industrialization in the early 1990s. |
| Transmission cycle broken in mid-2000s through intense prevention and vector control. | Threat to POR of importation from neighboring endemic municipalities. | Threat to POR from migrant workers and military camps. | Outbreak cases were limited to specific rural areas. | |
| Zero indigenous cases since 2010. | ||||
| Strategies and intervention choice | Scale-up of all activities with support of external funding. | Emphases on IEC and surveillance for elimination and POR | Emphasized IEC, surveillance for elimination and POR | 100% coverage of IRS and LLINs in 2009 & 2010, active case detection in areas affected by outbreak. |
| 100% LLIN coverage achieved in 2008; reoriented toward elimination in 2009. | 100% IRS, ITN distribution/retreatment in target areas by 1998. | |||
| Continuation of activities at reduced levels in more targeted areas as cases decline. | Personnel for ongoing surveillance, IEC and M/M&E activities retained. | Personnel for ongoing IEC, M/M&E and surveillance activities retained. | IRS and active surveillance discontinued when cases and resources declined post-outbreak. | |
| Funding resources | GFATM grants provide the majority of funds while LGUs contribute an increasing share. | Domestically financed; rely on emergency allocation if outbreak occurred. | Domestically financed; rely on regional office if outbreak occurred. | LGUs provided majority of funds; national contributions increased during outbreak response. |
| LGUs will need to support most activities when GFATM grants expire in 2014. | LGU’s provided majority of funds during elimination and POR for surveillance and integrated IEC by local health workers. | Significant funding by national during CLM and elimination, but shifted to LGUs for POR. | Domestically funded, requiring efficiency and narrow targeting of interventions. | |
| Program structure and leadership | Devolved program led by PHO staff, implemented by MHOs with extensive NGO technical assistance. | Devolution had little effect on malaria activities since zero indigenous cases already achieved at that time. | Regional staff led malaria activities. | Devolved program managed by local health staff under supervision of provincial malaria coordinator. |
| Minimal involvement of regional/national staff. | PHO staff continued to provide technical assistance and supported municipal health offices | Technical capacity retained through devolution. | Outbreak response required leadership and supervision by regional experts. |
Note: CLM = controlled low-endemic malaria; GFATM = Global Fund to Fight AIDS, TB, and Malaria; IEC = information and education campaign; IRS = indoor residual spraying; LGU = local government unit; LLIN = long-lasting insecticide treated net; MHO = Municipal health office; PHO = Provincial health office; POR = prevention of reintroduction.